diferential diagnosis of ulcers

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    RajendranNavaradnasinkam ,

    CRI .

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    INFECTIVE LESIONS

    BACTERIAL DISEASES

    SYPHILIS

    GONORRHOEA

    TUBERCULOSIS

    LEPROSY

    ACTINOMYCOSIS NOMA

    ANUG

    VIRAL DISEASES

    ACUTE HERPETIC GINGIVOSTOMATITIS HERPES LABIALIS

    HIV INFECTION

    INFECTIOUS MONONUCLEOSIS

    HERPES ZOSTER

    MEASLES

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    FUNGAL DISEASESFUNGAL DISEASES

    SPOROTRICHOSISSPOROTRICHOSIS

    HISTOPLASMOSISHISTOPLASMOSIS

    CRYPTOCOCCOSISCRYPTOCOCCOSIS

    MUCORMYCOSISMUCORMYCOSIS

    TRAUMATIC CONDITIONSTRAUMATIC CONDITIONS

    MECHANICALMECHANICAL

    THERMALTHERMAL

    CHEMICALCHEMICAL

    FACTITIOUS INJURYFACTITIOUS INJURY

    RADIATION INJURYRADIATION INJURY

    IMMUNOLOGICAL DISORDERSIMMUNOLOGICAL DISORDERSAPHTHOUS ULCERAPHTHOUS ULCER

    BECHETS SYNDROMEBECHETS SYNDROME

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    REITERS SYNDROMEREITERS SYNDROME

    ERYTHEMA MULTIFORMEERYTHEMA MULTIFORME

    PEMPHIGUSPEMPHIGUSPEMPHIGOIDPEMPHIGOID

    ULCERATIVE LICHEN PLANUSULCERATIVE LICHEN PLANUS

    DISCOID LUPUS ERYTHEMATOUSDISCOID LUPUS ERYTHEMATOUS

    SYSTEMIC DISEASESSYSTEMIC DISEASES

    LEUKEMIALEUKEMIA

    AGRANULOCYTOSISAGRANULOCYTOSIS

    CYCLIC NEUTROPENIACYCLIC NEUTROPENIA

    PERNICIOUS ANAEMIAPERNICIOUS ANAEMIA

    CHRONS DISEASECHRONS DISEASE

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    PRIMARY ORAL HERPES

    History of generalized prodromal symptomsthat precede the orallesions by 1-2 days.

    Small vesicles appear on the oral mucosa. They are thin walled

    surrounded by inflammation. They rupture leaving shallow round

    discrete ulcers.

    Entire gingiva is edematous and inflammed.

    ERYTHEMA MULTIFORME

    Starts as a bullae on an erythematous base. It rapidly breaks into

    irregular ulcers.Lesions are larger, irregular, deeper and often bleed.

    Involvement of lips are prominent while gingiva is rare.

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    CONTACT ALLERGIC STOMATITISCONTACT ALLERGIC STOMATITIS

    Reaction occurs at the site of contact.Reaction occurs at the site of contact.

    Includes burning sensation or soreness accompanied by erythemaIncludes burning sensation or soreness accompanied by erythemaand occasionally forming vesicles and ulcers.and occasionally forming vesicles and ulcers.

    ACUTE NECROTIZING ULCERATIVE GIGIVITISACUTE NECROTIZING ULCERATIVE GIGIVITIS

    Necrotic punched out ulcerationsNecrotic punched out ulcerations

    mostly developing in the interdentalmostly developing in the interdental

    papillae and marginal gingiva.papillae and marginal gingiva.

    A gray pseudomembranous covering.A gray pseudomembranous covering.

    Putrid halitosis and bad taste.Putrid halitosis and bad taste.

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    RECURRENT APHTHOUS STOMATITISRECURRENT APHTHOUS STOMATITIS

    Ulcers confined to oral mucosa with no other symptoms.Ulcers confined to oral mucosa with no other symptoms.

    Recurrent crops of dozens of small ulcers throughout the oral mucosa.Recurrent crops of dozens of small ulcers throughout the oral mucosa.

    Initially, a localized area of erythema develops, within hours, a smallInitially, a localized area of erythema develops, within hours, a smallwhite papule forms ulceration and gradually enlarges over the next 42-white papule forms ulceration and gradually enlarges over the next 42-72 hrs.72 hrs.

    Individual lesions are round, symmetric and shallow.Individual lesions are round, symmetric and shallow.

    Lesions less common on heavily keratinized palate or gingiva.Lesions less common on heavily keratinized palate or gingiva.

    Healing occurs without scarring.Healing occurs without scarring.

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    BEHCETS SYNDROMEBEHCETS SYNDROME

    Triad of symptoms include recurrent oral ulcers, recurrent genitalTriad of symptoms include recurrent oral ulcers, recurrent genitalulcers and eye lesions.ulcers and eye lesions.Most common single site is the oral mucosa.Most common single site is the oral mucosa.Lesions are similar to recurrent aphthous ulcers.Lesions are similar to recurrent aphthous ulcers.

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    RECURRENT HERPES SIMPLEX VIRAL INFECTIONRECURRENT HERPES SIMPLEX VIRAL INFECTION

    Occurs in patient with previous history of herpes simplex infection.Occurs in patient with previous history of herpes simplex infection.

    Prodromal period of tingling or burning, accompanied by edema at theProdromal period of tingling or burning, accompanied by edema at thesite of the lesion.site of the lesion.

    Its followed by formation of a cluster of small vesicles.Its followed by formation of a cluster of small vesicles.

    Large lesions are common in immuno suppressed individuals.Large lesions are common in immuno suppressed individuals.

    PEMPHIGOUS VULGARISPEMPHIGOUS VULGARIS

    Lesions begin as a classic bullae on aLesions begin as a classic bullae on a

    noninflamed base.noninflamed base.

    Oral lesions appear 3 months before skinOral lesions appear 3 months before skin

    lesions.lesions.

    Lesions are shallow and irregular, andLesions are shallow and irregular, and

    others have detached epithelium at theothers have detached epithelium at the

    periphery.periphery.

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    CICATRICIAL PEMPHIGOIDCICATRICIAL PEMPHIGOID

    Lesions present as intact vesicles of the gingival or other mucosalLesions present as intact vesicles of the gingival or other mucosal

    surface but appear more as nonspecific erosionssurface but appear more as nonspecific erosions

    BULLOUS PEMPHIGOIDBULLOUS PEMPHIGOID

    Gingival lesions include edema, inflammation and desquamationGingival lesions include edema, inflammation and desquamation

    with localized of discrete vesicle formation.with localized of discrete vesicle formation.

    EROSIVE LICHEN PLANUSEROSIVE LICHEN PLANUS

    Present as white lesion.Present as white lesion.

    Presence of vesicles, bullae or irregular shallow ulcers of the oralPresence of vesicles, bullae or irregular shallow ulcers of the oralmucosa.mucosa.

    Lesions present for weeks to months.Lesions present for weeks to months.

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    HISTOPLAMOSISHISTOPLAMOSIS

    Lesions appear as a papule, a nodule, an ulcer or a vegetation.Lesions appear as a papule, a nodule, an ulcer or a vegetation.

    If a single lesion is left untreated, it progresses from a firm papule toIf a single lesion is left untreated, it progresses from a firm papule to

    a nodule which ulcerates and slowly enlarges.a nodule which ulcerates and slowly enlarges.

    MUCORMYCOSISMUCORMYCOSIS

    ulceration of the palate, which results from necrosis due to invasionulceration of the palate, which results from necrosis due to invasion

    of palatal vesicles.of palatal vesicles. The lesions is large and deep, causing denudation of underlyingThe lesions is large and deep, causing denudation of underlying

    bone.bone.

    Ulcers in gingiva, lip and alveolar ridge.Ulcers in gingiva, lip and alveolar ridge.

    OSTEORADIONECROSISOSTEORADIONECROSIS

    Ulceration in overlying skin or mucosa especially followingUlceration in overlying skin or mucosa especially followingextraction of a tooth, denture ulceration, trauma, etc.extraction of a tooth, denture ulceration, trauma, etc.

    Secondary infections lead to radiation osteomyelitis.Secondary infections lead to radiation osteomyelitis.

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    LEUKEMIALEUKEMIA

    Gingival hyperplasia with bleeding in the most common oralGingival hyperplasia with bleeding in the most common oralmanifestation.manifestation.

    Ulceration of the sulcular epithelium and necrosis of the connectiveUlceration of the sulcular epithelium and necrosis of the connectivetissue leads to severe spontaneous gingival bleeding.tissue leads to severe spontaneous gingival bleeding.

    ANGULAR CHELITISANGULAR CHELITISFeeling of dryness of the mouth and burningFeeling of dryness of the mouth and burningsensation at the corner of the mouth.sensation at the corner of the mouth.

    Epithelium at the commisures appearEpithelium at the commisures appear

    wrinkled. In time, wrinkling becomes morewrinkled. In time, wrinkling becomes morepronounced to form deep fissures or crackspronounced to form deep fissures or crackswhich appear ulcerated, but which do notwhich appear ulcerated, but which do nottend to bleed.tend to bleed.

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    SYPHILISSYPHILIS

    PRIMARY SYPHILISPRIMARY SYPHILIS

    ChancreChancre occurs on the lip, tongue, palate, gingiva, tonsils, etc.occurs on the lip, tongue, palate, gingiva, tonsils, etc. Chancre are ulcerated, indurated lesions covered by a grayish whiteChancre are ulcerated, indurated lesions covered by a grayish white

    membrane and often mistaken for early carcinoma.membrane and often mistaken for early carcinoma.

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    SECONDARY SYPHILISSECONDARY SYPHILIS Mucous patchesMucous patches are seen over the to